Remote Quality Management RN (Contract)
Contract: length is 6 months to 2 years (potential to convert to permanent position)
Setting: Not for profit health plan / managed care environment
$51 per hour, 40 hours per week
We’re seeking an experienced Remote Quality Management RN to support quality-of-care investigations and adverse incident review. This role is ideal for a detail-driven nurse who enjoys clinical chart review, identifying areas of quality improvement, and then creating a plan of action.
What You’ll Do
- Chart review - Investigate and process Quality of Care (QOC) reviews and adverse incident cases
- Request, review, and summarize medical records to support clinical investigations
- Present case summaries to Physician Medical Reviewers and clinical leadership
- Document findings in internal tracking systems with accuracy and completeness
- Identify provider outliers, propose corrective action plans, and monitor compliance
- Track and evaluate trends in QOC issues to support reporting needs
- Support contract compliance with state requirements and URAC standards
- Collaborate with Population Health, IT, and Quality teams on data and reporting needs
What You Bring
- Active RN license; BSN preferred
- 3–5 years clinical nursing experience
- 1+ years of quality improvement, performance improvement or quality management experience required
- Experience with QOC reviews, adverse incidents, CMS requirements, HEDIS, URAC, or health-plan quality work (preferred)
- Strong understanding of clinical documentation, case review, and quality criteria
- Proficiency in EHRs, data entry, Microsoft Excel, Word, and Outlook
- Exceptional attention to detail, organization, and communication
- Ability to escalate issues appropriately and manage multiple priorities
Pay: $51.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Flexible spending account
- Health insurance
- Vision insurance
Application Question(s):
- We are only considering candidates who currently reside in CT, MA, RI, NH, VT, ME or NY. If you do not reside in one of these states, please do not apply (you will not be considered). In which state do you reside?
- This is a contract position lasting between 6 months and 2 years. There is potential for this to transition to direct-hire, permanent. Are you comfortable moving forward knowing this is a contract role?
Experience:
- RN: 3 years (Required)
- Quality improvement: 1 year (Required)
Work Location: Remote
